Finger amputations are serious injuries that involve the loss of phalanges of one or more fingers.
Finger amputations mostly occur in the distal phalanges of the long fingers and may include the bone as well as the soft tissue including the skin, tendons, vessels, nerves and nail bed. Amputations may also affect one or multiple fingers and extend to the hand palm.
Finger amputations are classified according to the extent of finger loss and the mechanisms leading to an amputation.
Minor finger injuries involve primarily the soft tissue without exposing the bone. These types of injuries normally do not require surgery but a thorough hygiene regime with dressing and disinfectants to prevent infections.
Extensive finger injuries with bone exposure may include damage to the phalanges. The bone is surgically shortened to allow reconstruction with a soft tissue flap to cover the wound.
Traumatic amputations consist in the total severing of the finger at the time of accident, which may occur at various phalange levels. Depending on the conditions of the amputated part and time from the accident, the surgeon may opt for replantation if conditions are suitable. In young children replantation can allow for a relative normal finger growth.
Finger amputations are a frequent result of crush incidents or cutting injuries when handling sharp utensils and machines. Amputations occur either directly during the injury itself or as a consequent surgical amputation when the damage is so extensive that the finger cannot be preserved. Finger amputations arise from a large number of mechanisms such as:
Severing by sharp knives, blades and machineries
The main risk factors for finger amputations are:
Maneuvering of industrial and farming tools and machineries (axes, mixers, chain saws)
Crush injuries (car doors, hammers, machine parts, pressure or fall of heavy objects)
Home power tools
Handling of explosive material or devices
The symptoms of a finger amputation are:
Finger and/or hand deformity
Separation of amputated finger extremity
The severity of finger amputation depends on the extent of tissue that has been lost and whether one or more fingers are involved. A partial or total finger amputation should be assessed immediately after injury and managed as described below. Medical examination will evaluate the possibility of replanting the amputated finger to determine:
Changes in the anatomy of the affected finger(s) against the healthy fingers
Extent of damage to soft tissue and phalangeal bones
Severity of bleeding
Changes in finger/hand function
Risk of infection
X-rays are taken to assess the degree of damage to the phalanges to guide therapy towards surgical reconstruction or potential finger replantation.
Management of finger amputations varies in relation to the number of fingers amputated, the phalangeal level at which the amputation has occurred and the integrity of the soft tissue remaining. Conservative or minimal surgical treatment is employed in minor finger amputations affecting the soft tissue. These are usually managed immediately in the Emergency Room and include:
Additional treatment includes:
Debridement (removal) of crushed soft tissue
Application of ice pads
Administration of NSAIDs
Administration of antibiotics
Splint to prevent movement of the fingers
After obtaining the X-rays the surgeon determines the degree of damage to the fingers and hands. The surgical approach takes into consideration the balance between finger amputation and replantation, relative to the functional outcome and cosmetics. In case of fingertip amputation, the surgeon removes the dead tissue, shortens the bone if necessary, and closes the extremity with a tissue flap.
If the amputation is extensive (involving the phalanges and soft tissue), the detached extremity is preserved under sterile and moist condition for a possible replantation. A soft tissue graft taken from other body parts may be required in case of abundant tissue loss. The goal of surgery is to create a suitable anatomy to eventually fit a finger prosthesis if replantation is not possible.
Reattachment of amputated fingers has a high rate of success but only achieves 50% of normal function. Replantation is not recommended if amputation occurs at the fingertip, single finger, finger base, crush injuries or infection, but is advised in children and following multiple amputations including the thumb.
For example, with the loss of the fifth finger, surgery may retain the corresponding fifth metacarpal bone of the hand, which is aesthetically less likable but functionally superior, or remove it to achieve a continuous contour of the palm. In the second case a smaller palm will lose part of the strength and gripping function.
Complications following a finger amputation differ relative to severity and treatment modalities.
Poor wound healing
Loss of function
Loss of sensation
After finger replantation:
Loss of sensation
Altered temperature control
Prolonged period of recovery
A physical or occupational therapist provides the patient with an exercise plan to restore flexibility and strength of the hand following an amputation and learn the use of the hand with a finger prosthesis. Education is pivotal to modify activities when one or more fingers have been lost. Additional rehabilitative therapy includes:
Massage Ice or heat packs
Stretches and return to activity plan
The aim of prevention is to reduce the risk of finger amputations by protecting the hands in any physical activity. Common strategies are:
Use of gears to reduce exposure of fingers when using machines/tools
Construction of machines with safeguard technology
Implementation of occupational health and safety regulations in the workplace